Association of Diabetes-related Emotional Distress with Diabetes Self-care and Glycemic Control among Adult Patients with Type 2 Diabetes at a Tertiary Hospital in Manila, Philippines

  • Darwin Totesora The Medical City, Ortigas
  • Marie Isobelle Ramos-Rivera The Medical City
  • Mary Queen Villegas-Florencio The Medical City
  • Pia Natalya Reyes-Sia The Medical City
Keywords: emotional distress, Filipino, self-care, diabetes self-management questionnaire


Objective. The study aims to determine the association of diabetes-related emotional distress with reported diabetes selfcare, and glycemic control of adult Filipinos with type 2 diabetes mellitus at The Medical City using 2 psychometric tests.

Methodology. This is a cross-sectional study conducted among 94 Filipinos diagnosed with type 2 diabetes mellitus, who answered 2 validated English questionnaires: Problem areas in diabetes (PAID-20) and Diabetes self-management questionnaire (DSMQ) that screen for diabetes-related emotional distress and diabetes reported self-care, respectively. Data were encoded and analyzed using Stata SE v.13.

Results. 42.6% of Filipinos with type 2 diabetes mellitus had emotional distress showing moderate to severe distress in factor 1 (diabetes-related emotional distress) and factor 3 (food related problems). 51.1% had suboptimal self-care, poorly scoring in areas of health-care use and dietary control. Majority of those who had diabetes-related distress and poor self-care where young, pre-obese and had diabetes duration of ±5 years. There was no significant association between diabetes-related emotional distress with diabetes self-care and emotional distress with glycated hemoglobin, but majority of those who had diabetes distress had higher glycated hemoglobin. There was significant association between diabetes self-care and glycemic outcomes (p=0.006) with relative risk of 1.51 (95% CI 1.10-2.07). There was linear inverse weak correlation between all subdomains of DSMQ with glycated hemoglobin except Dietary Control.

Conclusion. Diabetes-related emotional distress and sub-optimal self-care are prevalent among Filipinos with type 2 diabetes mellitus. Those who had poor self-care were 1.5 times more likely to have poor glycemic outcomes.


Download data is not yet available.

Author Biographies

Darwin Totesora, The Medical City, Ortigas


Section of Endocrinology, Diabetes and Metabolism

Department of Medicine

Marie Isobelle Ramos-Rivera, The Medical City

Department of Psychiatry

Mary Queen Villegas-Florencio, The Medical City

Section of Endocrinology, Diabetes and Metabolism

Department of Medicine

Pia Natalya Reyes-Sia, The Medical City
Department of Psychiatry


World Health Organization. Global report on diabetes, 2016.

UNITE for Diabetes Philippines. Compendium of Philippine Medicine, 2013. 2013/06/Diabetes-United-for-Diabetes-Phil.pdf.

American Diabetes Association. Standards of medical care in diabetes 2017;40(Suppl 1):s48-s56; s57-s8.

Welch GW, Johnson AM, Polonsky WH. The problem areas in Diabetes Scale: An evaluation of its clinical utility. Diabetes Care. 1997;20(5):760-6.

Chew BH, Shariff-Ghazali S, Fernandez A. Psychological aspect of diabetes care: Effecting behavioral change in patients. World J Diabetes. 2014;5(1);796-808.

Fisher L, Hessler DM, Polonsky WH, Mullan J. When is diabetes distress clinically meaningful? Establishing cut points for the Diabetes Distress Scale. Diabetes Care. 2012;35(2):259-64. PMID: 22228744.PMCID: PMC3263871.

Fisher L, Mullan J, Skaff MM, Glasgow RE, Arean P, Hessler D. Predicting diabetes distress in patients with type 2 diabetes: A longitudinal study.Diabet Med. 2009;26(6):622-7.

Polonsky WH, Anderson BJ, Loher PA, et al. Assessment of diabetes-related distress. Diabetes Care. 1995;18(6);754-60.

Lee J, Lee EH, Kim CJ, Moon SH. Diabetes-related emotional distress instruments: A systemic review of measurement properties.International journal of nursing studies. 2015;52(12); 1868-78.

Alberti G. The DAWN (diabetes, attitudes, wishes and needs) study.Pract Diabetes Int. 2002;19(1); 22-4.

Schmitt A, Gahr A, Hermanns N, Kulzer B, Huber J, Haak T. The Diabetes Self-Management Questionnaire (DSMQ): Development and evaluation of an instrument to assess diabetes self-care activities associated with glycemic control. Health Qual Life Outcomes.2013;11:138.

Schmitt A, Reimer A, Hermanns N, et al. Assessing diabetes self-management with the Diabetes Self-Management Questionnaire (DSMQ) can help analyze behavioural problems related to reduced glycemic controls. PloS One. 2016;11(3): e0150774.

Snoek FJ, Pouwer F, Welch GW, Polonsky WH. Diabetes-related emotional distress in Dutch and U.S. diabetic patients: Crosscultural validity of the problem areas in diabetes scale. Diabetes Care. 2000;23(9):1305-9. PMID: 10977023.

Miller ST, Elasy TA. Psychosomatic evaluation of the Problem Areas in Diabetes (PAID) survey in Southern, rural African American women with Type 2 diabetes. BMC Public Health. 2008;8:70. 10.1186/1471-2458-8-70.

Lee EH, Lee YW, Lee KW, Kim YS, Nam MS. Measurement of diabetes-related distress using the Problem Areas in Diabetes scale:Psychometric evaluations show that the short form is better than the full form. Health Qual Life Outcomes. 2014;12:142.

Snoek FJ, Kersch NYA, Eldrup E, et al. Monitoring of Individual Needs in Diabetes (MIND)-2. Diabetes Care. 2012;35(11):2128-32.

Schmitt A. Diabetes Self-Management Questionnaire (DSMQ), 2013.

Nicolucci A, Kovacs Burns K, et al. Diabetes attitudes, wishes and needs second study (DAWN2TM): Cross-national benchmarking of diabetes-related psychosocial outcomes for people with diabetes. Diabet Med.2013;30(7):767-77.

Skovlund S, Peyrot M. The diabetes attitudes, wishes and needs (DAWN) program: A new approach to improving outcomes of diabetes care. Diabetes Spectrum.2005;18(3): 136-42.

Jimeno CA, Sobrepeña LM, Mirasol RC. DiabCare 2008: A survey on glycemic control and the status of diabetes care and complications among patients with type 2 diabetes mellitus in the Philippines. Philipp J Int Med. 2012;50(1):15-22.

Stranderg RB, Graue M, Wentzel-Larsen T, Peyrot M, Rokne B. Relationship of diabetes-specific emotional distress, anxiety, and overall well-being with HbA1C in adult with type 1 diabetes. J Psychosom Res. 2014;77(3):174-9.

Strandberg RB, Graue M, Wentzel-Larsen T, Peyrot M, Thordarson HB, Rokne B. Longitudinal relationship between diabetes-specific emotional distress and follow-up HbA1c in adults with type 1 diabetes mellitus. Diabet Med. 2015;32(10):1304-10.

PMC4676291. 10.1111/dme.12781.

Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). UK Prospective Diabetes Study Group (UKPDS) Group. Lancet. 1998;352(9131):837-53.

Ogbera A, Adeyemi-Doro A. Emotional distress is associated with poor self care in type 2 diabetes mellitus. J Diabetes. 2011;3(4):348-52.

Mehravar F, Mansournia MA, Holakouie-Naieni K, Nasli-Esfahani E, Mansournia N, Almasi-Hashiani A. Associations between diabetes self-management and microvascular complications in patients with type 2 diabetes. Epidemiol Health. 2016;38:e2016004. PMID: 26883737. PMCID: PMC4789607.

Bukhsh A, Lee SWH, Pusparajah P, Schmitt A, Khan TM. Psychometric properties of the Diabetes Self-Management Questionnaire (DMSQ) in Urdu. Health Qual Life Outcomes. 2017;15(1):200.

How to Cite
Totesora, D., Ramos-Rivera, M. I., Villegas-Florencio, M. Q., & Reyes-Sia, P. N. (2019). Association of Diabetes-related Emotional Distress with Diabetes Self-care and Glycemic Control among Adult Patients with Type 2 Diabetes at a Tertiary Hospital in Manila, Philippines. Journal of the ASEAN Federation of Endocrine Societies, 34(2), 189-196.
Original Articles